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General NPI Number Information
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NPI Number | 1780848945
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL CLINIC, PC
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 3211 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60625-5208
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Country | US
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Telephone | 773-463-1904
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Fax | 773-463-1257
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Provider Business Mailing Address
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Address Line | 3211 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60625-5208
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Country | US
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Telephone | 773-463-1904
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Fax | 773-463-1257
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MOHAMMAD ZAFFARKHAN
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Credential |
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Telephone | 773-463-1904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 01901529
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License Number State | IL
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